Beyond substitution: how medical cannabis patients manage prescription medications

Background Medical cannabis policies often raise concerns about substitution of prescription medications with cannabis, yet most evidence is quantitative. Drawing on the concept of lay pharmacology, this qualitative study examined how medical cannabis patients manage prescription medications alongside cannabis use.Methods Data were drawn from an ongoing cohort of Pennsylvania-based medical cannabis patients. Thirty-seven participants (mean age = 38, 62% female) with a history of prescription medication use completed qualitative interviews in 2022-2023. Iterative thematic analysis identified medication management strategies.Results Participants described complex medication histories and concerns about prescription medications, including pill burden, side effects, limited efficacy, and addiction risk. However, they differed in how they managed prescription medications in the context of cannabis use. Three strategies were identified: (1) Medication Cessation (n = 8), involving discontinuation of all prescription medications in favor of cannabis; (2) Medication Reconfiguration (n = 14), characterized by dose reduction, selective discontinuation, or alternating medications with cannabis; and 3) Medication Prioritization (n = 15), in which participants maintained prescription regimens while adjusting cannabis use.Conclusion Complete substitution was uncommon. Instead, patients engaged in adaptive, experience-based medication management consistent with lay pharmacology. Findings highlight the need for policy frameworks and clinical guidelines that support individualized, patient-centered, and collaborative approaches to care.